Primary care physicians in the United States are not alone in their struggle to coordinate care for patients with chronic or mental illnesses, a recent international survey(www.commonwealthfund.org) of physicians indicates.
Technology, a lack of shared data with other health professionals and payment restrictions were common limiting factors cited in the study by the Commonwealth Fund, which was published recently(content.healthaffairs.org) in Health Affairs. The authors concluded that a stronger primary care infrastructure is the first step toward a solution.
The survey asked primary care physicians in 10 Western countries to evaluate their ability to care for patients who are considered the costliest, along with their overall experiences in dealing with the health care system.
The survey illustrated that coordinating care requires that all health care professionals be able to view the same information about a patient. This sounds simple in theory but is proving difficult to achieve in the real world.
- A recent survey of physicians in 10 Western countries shows common factors limiting better care coordination for patients with complex health needs.
- Physicians in the United States score highest in allowing patients to access information from their medical records, but lowest for being able to arrange after-hours care outside the ER.
- The researchers said constant innovation will be critical to improving care coordination.
Physicians in Western Europe have been faster to adopt electronic heath records compared with clinicians in the United States and Canada, but adoption does not necessarily mean that information is exchanged easily. Among physicians in the United States, Canada, Germany and Australia, fewer than half could exchange clinical summaries electronically. Physicians in the United States scored highest (60 percent) in terms of allowing patients to access information from their medical records.
One of the biggest obstacles to greater care coordination is obtaining information about a patient's treatment outside the primary care physician's office. Only 31 percent of U.S. physicians said they were always informed when a patient was discharged from a hospital, and only 32 percent said they were notified when a patient was seen in the ER.
"Few countries have found effective solutions, and integrating care across silos is difficult -- even in countries such as Norway, where primary care, community care and social services all operate under the auspices of the municipalities," the authors wrote.
The United States showed a particular need for improvement in several categories, the authors said.
Only one in six physicians in the United States and Sweden said their practice was well prepared to manage chronic care patients who had severe mental illness or substance abuse, for instance. And only 39 percent of physicians in the United States -- the lowest rate among countries surveyed -- and 48 percent in Canada could arrange for after-hours care without sending a patient to the ER. As a result, these two countries recorded the highest ER usage rates. The United States also ranked last for physicians who make house calls -- just 6 percent.
"The need to bolster primary care in the United States is critical," the authors wrote. "Among the 10 countries in this survey, the United States has the youngest population, yet it has the highest incidence of chronic disease and spends 50 to 150 percent more on health care per capita than the other nine countries."
U.S. and British physicians report a similar level of dissatisfaction with their overall health systems, quality of care and their careers, which leads to more physicians considering early retirement and fewer students choosing primary care.
Physicians also cited frustration with the fee-for-service model in the United States, Canada, Norway and Germany. A notable exception was Switzerland, where physicians reported high levels of cooperation with specialty and home care professionals while using the model.
Improving care coordination will take time as different reforms are tested to see which are successful, but a commitment to trying new approaches is critical, the authors concluded.
"To succeed, the United States may need to do more to strengthen primary care, with policymakers keeping an open mind about new ideas, including those that have demonstrated effectiveness in other countries," the authors wrote.